Inside Dental Technology
Opening the Lines of Communication
The increasing compatibility of CAD/CAM systems creates new opportunities for laboratory owners.
Good communication in today’s dental laboratory is not just about having open dialogue among team members, it means choosing technologies that interact well with each other too. In the last 2 years, CAD/CAM technology manufacturers have made great strides in improving the compatibility of their systems with others on the market. Previously, CAD/CAM users did not have many choices—they either found themselves locked into closed systems that used proprietary materials or had to accept the limited restorative options offered by the few open-architecture systems available. Either way, consumers faced the very real possibility that their purchase could become obsolete in just a few years.
Laboratory owners no longer face many of those challenges because CAD/CAM technology has advanced to keep up with the rapidly changing industry. Closed architecture is quickly becoming a thing of the past. Many major manufacturers have opened their systems to both closed and open partners to expand their range of services and maintain their customer base. Connectivity to a variety of machines and milling/printing options continues to expand, enabling users to select a system with technology that better serves their business model and the unique needs of their customers.
These advances have inspired laboratory owners Don Albensi, CDT, and Larry Stites to explore new business opportunities. Stites is planning to make Allure Dental Studio in Tracy, California, the first truly digital dental laboratory, while Albensi wants to make Albensi Laboratories in Irwin, Pennsylvania, the first laboratory in the United States to have 100 intraoral impression scanning units in clients’ offices. As digital technology and connectivity continue to evolve, it is likely the industry will see many more firsts come to fruition.
Committed to Digital
Stites is no stranger to digital technology—as the former vice president of research and development for MicroDental Laboratories in Dublin, California, he has worked with all kinds. Two years ago, he and his colleague Frank Charles Pope, MicroDental’s former vice president of operations, left the company to pursue their dream of opening their own laboratory. They opened the doors of Allure Dental Studio in 2008 and now have a staff of nine serving 70 clients. “We wanted to create the first truly digital dental laboratory in the country,” Stites says. “That has been our focus for the past 2 years, and I would say we are 98% there.” With the exception of removable cases, every case that comes into the laboratory is scanned and designed using the 3Shape scanner and design software add (www.3shape.com). The impression scan is immediately transmitted to Allure’s Eden260V™ 3-D printer (Objet Geometries Inc, www.objet.com) for model output, and the design data is either sent to an outsource center for milling frameworks or full-contour restorations or sent to the 3-D printer for printing a resin mock-up for traditional casting or pressing. Initially, Stites poured stone models (Figure 1) to validate the reproduction accuracy against the 3-D printed model. Not only did he discover that the two line up perfectly (Figure 2), but the 3-D printed model is more accurate in some instances, especially when a feather-edge margin is questionable. He finds the digitally placed margin is more accurate than what his technicians can manually trim.
Allure also has created its own tooth anatomy library (Figure 3) by scanning in hundreds of natural human teeth and picking four or five of each to use for all full-contour designs or larger cosmetic cases where they work with a fullcontour design and then cut back 1 mm to 1.5 mm for layering porcelain. “We are now awaiting the next wave of intraoral scanners so that we can eliminate the impression scan and go simultaneously and seamlessly to the 3-D printer for the model and to the CAD software for design,” Stites explains.
Technology has really come into play on the large, complex cases that Allure handles. Stites and his partner believe their laboratory’s unique ability to blend technology and high-end cosmetic implant cases fills a niche in the market that is currently not being addressed. The integration of technology in the laboratory to physically produce a case in wax prior to production will help to bolster this growing segment of the industry. “When designing an implant case, most laboratories design the frame from the inside out,” Stites says. “We take that case and scan the study model, preoperative model, or mock-up model with the end result in mind and then reverse engineer it and print the case on our 3-D printer” (Figure 4). Stites sends the dentist the articulated mock-up of the case along with the verification matrix from the scan of the original go-by model. In some situations, the dentist actually removes the wax mock-up and tries it in the patient’s mouth to verify fit.
Reverse engineering large cases has saved Allure and its clients thousands of dollars when what the client wants does not match up with what was sent to the laboratory. “We recently received a large case involving 28 single IPS e.max® [Ivoclar Vivadent, www.ivoclarvivadent.us] restorations,” Stites says (Figure 5). “When we printed the complete designed case in resin and seated it on the model, the facebow mounting did not line up. The ability to validate a large case like this saved our client $6,600 for the finished crowns and saved us $1,500 in milling blocks,” he explains (Figure 6, Figure 7 and Figure 8).
Scan, Print, Press
When the Progress IODIS (Clōn 3D, www.clon3d.com) open-architecture intraoral digital impression system launched in February 2010, Albensi heard opportunity knocking. The business model made sense to him. By making a commitment for 12 units per month, he could create a partnership in which dentists could receive an intraoral impression scanner and a rebate from his laboratory for the monthly $350 leasing fee. He could fabricate the crowns in 48 to 72 hours in his US laboratory using restorative 3-D wax print-and-press production and sell them for a more competitive price. “Currently the most efficient crown we can manufacture in the laboratory is one that we CAD design, rapid prototype, print full-contour in wax, and press,” Albensi says. “It saves 70% in manufacturing cost over previous CAM methods.”
But there has been a hitch—the Clōn 3D order is still pending. At first, Albensi was milling the 25+ CEREC® (Sirona, www.sirona.com) crowns that were coming into his laboratory every day at a milling block cost of $28 per crown. That is, until he realized he could achieve the same goal using his 3Shape scanner, which had newly introduced connectivity to the Lava™ Chairside Oral Scanner C.O.S. (3M ESPE, www.3mespe.com). “When the Lava C.O.S. opened up to the 3Shape system, I had all the compatible equipment in place to produce competitively priced IPS e.max crowns,” Albensi says. “The need for 3M to produce a $20 SLA model was found to be unnecessary for single posterior restorations, which account for 60% of all laboratory cases. I could simply receive the scan, design, print, and press the crown.” He branded this fabrication method the PG-Pro™. If his clients do not require a model with the restoration, Albensi can use the PG-Pro method to reduce the cost of a single unit to $99, which is $30 less than the same unit fabricated conventionally and just slightly more expensive than crowns manufactured in overseas facilities. But the true value to his customers is in the 2- to 3-day turnaround.
Getting the Lava C.O.S. scanners in the hands of clients has presented the largest challenge—the scanners are expensive to buy and the monthly payments are high. But Albensi offers his clients several partnership programs to help offset the cost of incorporating an intraoral impression scanner in the operatory. The most attractive option entails a rebate from the laboratory for $230 a month on the lease fee in return for a commitment of 5 years of use and $2,500 of work per month from the dentist. Using this agreement, the cost of a single restoration can be reduced to as low as $85. Recently, Albensi held a seminar for 12 of his clients to present the Lava C.O.S. partnership program, and eight eventually signed up.
Albensi currently has six design stations in his laboratory handling the intraoral scans coming from both the Lava C.O.S. (Figure 9, Figure 10 and Figure 11) and CEREC® Bluecam (Sirona). The ProJet™ 3-D printer (3D Systems, www.3dsystems.com) can produce 120 crowns in wax in approximately 4 hours (Figure 12). The wax copings are invested and pressed (Figure 13), then stained, glazed, fired (Figure 14), and shipped within 48 hours.
Albensi just put an order in for another ProJet to handle the projected volume. Essentially, he has an assembly line process in place—what used to entail 2 hours of labor now takes just 18 minutes. “I believe there is still an opportunity for the small laboratory owner to take advantage of this technology at a variety of levels,” he says. “I currently supply several laboratories with wax prints that only desire to invest in the scanner and CAD systems. It is imperative that laboratories get involved with a digital process if they want to better position themselves for the future.”